The accuracy of ultrasound elastography in nodal staging of head and neck squamous cell carcinoma (HNSCC) compared to CT, MRI and PET-MRI

Aim Accurate clinical staging of cervical lymph nodes is essential for therapy planning in HNSCC patients, particularly in cases of non-surgical treatment without pathological staging. The aim of this study was to evaluate the accuracy of ultrasound elastography (UE) compared to B-mode ultrasound (US), CT, MRI and PET-MRI for cervical lymph node staging in HNSCC patients.

Methods Cervical lymph nodes in patients with HNSCC were examined with UE, US, CT, MRI and PET-MRI. All patients underwent surgical therapy and the histopathological N-findings were compared to the clinical findings.

Results 13 lymph nodes in cervical levels II-IV in 5 patients showed pathological findings on MRI, UE and CT and were further examined using UE. 8/13 lymph nodes had a higher degree of stiffness as measured by UE, which correlated with a higher glucose metabolism detected on PET-MRI. Metastases were found in 4/14 lymph nodes upon histopathological examination.

All metastatic lymph nodes were among the lymph nodes with enhanced PET-tracer uptake and their elastography scores (ES) measured via UE were highest compared to all other assessed nodes.

Conclusion US, UE, CT MRI and PET-MRI offer a high level of sensitivity and lower levels of specificity in the workup of cervical lymph nodes in HNSCC patients. UE including ES measurement could potentially improve the diagnostic accuracy and increase the specificity of clinical neck staging compared to in comparison to US, CT und MRI. In this current study, the specificity of UE to predict nodal involvement seems similar to PET-MRI but further studies comparing these two modalities are necessary.

Publication History

Article published online:
24 May 2022